Venier et al. Neurosurg Cases Rev 2018, 1:008 Volume 1 | Issue 1 Citaton: Venier A, Roccatagliata L, Cianfoni A, Pravatà E (2018) Multmodal MRI of Extracranial Glio- blastoma Disseminaton. Neurosurg Cases Rev 1:008. Accepted: December 13, 2018; Published: December 15, 2018 Copyright: © 2018 Venier A, et al. This is an open-access artcle distributed under the terms of the Creatve Commons Atributon License, which permits unrestricted use, distributon, and reproducton in any medium, provided the original author and source are credited. Open Access Neurosurgery - Cases and Reviews • Page 1 of 3 • Venier et al. Neurosurg Cases Rev 2018, 1:008 Multmodal MRI of Extracranial Glioblastoma Disseminaton Alice Venier 1* , Luca Roccatagliata 2 , Alessandro Cianfoni 3 and Emanuele Pravatà 3 1 Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland 2 Department of Scienze della Salute, University of Genoa, Genoa, Italy 3 Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland *Corresponding author: Alice Venier, MD, Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Via Tesserete, 46-6900, Lugano, Switzerland, Tel: +41-918-116-872 therapy (Intensity-Modulated Radiaton Therapy) and chemotherapy (Temozolomide) were performed but, afer 1 year, he underwent a second surgical excision for local relapse, followed by Bevacizumab treatment. This relapse was located in the lef post-central gyrus and underwent to a gross total resecton. At the clini- cal follow up performed fve months later, the patent presented with a stf palpable mass within the extrac- ranial sof tssue at the level of the craniotomy. Mult- modal MRI, including structural T2 and post-Gadolin- ium T1 weighted sequences, as well as difusion and perfusion-weighted sequences, was performed. The scalp mass exhibited typical MRI characteristcs found in glioblastoma tssue: low signal on T2-weighted imag- es, marked and inhomogeneous contrast enhancement, relatvely low difusivity values suggestng hypercellu- larity and increased perfusional blood volume, a marker of neovascularity (Figure 1). There is not a post-mortem histology that could confrm the radiological diagnosis. Considered the poor general clinical conditon of the pa- tent, it was decided to perform palliatve radiotherapy on the scalp lesion. The patent died few months afer. Discussion We showed a case where multmodal MRI could non- invasively demonstrate an extracranial disseminaton of glioblastoma recurrence, and at the same tme excluded other potental causes for scalp swelling, such as infecton and/or dural defect. Converging MRI lesions features typical for a hyperperfused, hypercellular solid tssue, strongly supported diagnosis, and allowed to avoid biopsy in a patent with poor general clinical status. Abbreviations MRI: Magnetic Resonance Imaging; WHO: World Health Organization; IDH: Isocitrate Dehydrogenase; MGMT: Methylguanine-DNA Methyltransferase CAsE REPoRt Check for updates Introducton Glioblastoma scalp disseminaton is uncommon. In- fltraton may occur through the craniotomy, suggestng difusion from the surgical site as the most likely mech- anism. At Magnetc Resonance Imaging (MRI), features of the metastatc tssue resemble those of the prima- ry tumor. We show multmodal MRI appearance of a glioblastoma disseminatng to the scalp. The patent presented with a stf, non-tender palpable mass within the extracranial sof tssues, fve months afer surgery. Distnctve fndings included low signal on T2 weighted images and relatvely low difusivity values suggestng hypercellularity, marked contrast enhancement, and increased perfusional blood volume, a marker of neo- vascularity. Case Descripton A 51-years-old, Caucasian man presented with par- tal faciobrachial seizure, with subsequent tonic-clon- ic generalizaton in April 2015. Imaging showed a lef post-central intra-axial mass lesion. Biopsy results were lower grade astrocytoma (IDH1-2 wild-type, 1p19q non-codeleted, EGFR amplifed, MGMT non-methyl- ated). He underwent partal surgical resecton due to tumor proximity to the sensorimotor cortex and cort- co-spinal tract. Histopathological fnding was a second- ary progression to glioblastoma WHO grade IV. Radio-